Wednesday, September 11, 2013

More Bipolar Psychology - Broken Ego Defenses





I first conceived of and wrote this piece proposing that "broken ego defenses" are a major factor in depression of all kinds (uni-polar depression and the depression found in bipolar, schizophrenia and other disorders) in the fall of 2013. The concept of "broken ego defenses" has fascinated me ever since. As such, I've since that time done much, much more research, both in understanding the neuronal and brain network workings of "ego defenses" and in real world study of human behavious. Shakespeare once wrote, "All the world is a stage." I could very well say, "All the world is a research lab." When I'm trying to understand a human behaviour and underlying science behind it, I study everybody and everything

So I've long wanted to do a major rewrite of my original piece and I'm finally getting around to it. 


What we're going to look at here also ties in a great deal to what we look at in the post on empathy and bipolar, or empathy in all highly empathetic people.


"Ego" gets a bad rap so first of all we need an understanding of what your ego is. 


A simple dictionary definition lists: self-esteem, self-importance, self-worth, self-respect, self-image. 


Nothing wrong with having any of those traits!


In the psychoanalytical sense, ego is defined as "the part of the mind that mediates between the conscious and the unconscious and is responsible for testing reality and a sense of personal identity". 


"Sense of personal identity" is the most important thing to take away there for our purposes today. 


And in philosophy and metaphysics, it is considered "a conscious thinking subject". I'm pretty sure we all qualify here, although I certainly know those times when it feels like we're neither conscious nor thinking! And by the way, if you don't understand the term 'metaphysics', don't worry, neither do I. And nor do I care. 


So we'll accept for our purposes for this post/chapter that "ego" means things like our concept of our own personal identity and self-esteem, self-image, etc. 


I think then that we can think of "ego" as "the self". 


And I think we can all agree that when we are in mental health crises and as these start to stretch from weeks or months into years and our lives and relationships all start to fall apart and go to shit, that our "self" takes an absolute pummeling. 


Or it is also very possible that it was our "self" taking this pummeling that began the crisis and downward spiral in the first place. 


Or it is even more possible that our "self" was pummeled in childhood and never developed healthily in the first place and that is the issue behind adulthood mental health issues. The more I study and the more I talk to people, the more I see this is a huge and widespread issue (though I shall leave childhood abuse and trauma for a different post and approach for now). I have to be clear that this is not an issue for me personally but it is now clear to me that it is for many. 


As important as the 'self' is, it is yet another aspect of our mental health that psychiatry does not deal with at all with their "chemical imbalance" and pharmacological treatment approach





Despite "modern" psychiatry and the intensive and wide spread use of drug therapy in the last several decades, the number of mentally disabled people who are on US's SSI disability rolls 
tripled between 1987 (the year Prozac hit the mental health landscape) and 2007. In the same twenty year span the number of children who are considered "disabled mentally ill" rose thirty-five foldRobertWhitaker makes a strong case in his book Anatomy of an Epidemic that a good deal of this can be explained by the debilitating effects of the drugs themselves. I heard a talk by Dr Tony Stanton some in the spring of 2013 in which he described his experiences running Seneca Center, a center in Washington State for unwanted foster children. One of the biggest problems most of the kids had was a lifetime of being forcibly medicated to "dampen" their "issues". He described how these kids' spirits rekindled and came alive after being numbed for years being on the drug cocktails they were forced to take (I attended a workshop of Tony's later that year to learn more and had the pleasure to be able to discuss these issues at length with him). My personal experience is that the worst two and a half years of my life were when I was on psychiatric drug cocktails.


After spending thirty months in a horrifying downhill slide from the summer of 2010 to the end of 2012 while under the care of numerous psychiatrists and all the mind numbing and brain damaging drugs (1) they pumped me full with, I started off the year 2013 wondering "why?" the mental health care system failed me (and tens of thousands of others) so badly and all I do is keep searching for the answer.

And I while I felt better in many ways when I stopped taking medications, I continued to be plunged into very dark periods and struggles.

So if coming off drugs wasn't completely the answer then what is it? Why do some of us suffer so badly? I just kept asking why and pursuing the answer. I've argued for some time that a lot of the issues with bipolar (and other mental health disorders such as schizophrenia) are largely psychologically based and that a big part of the problem we have is that these issues are not only not recognized, they are not dealt with by the system at all.

Let's now get more into one such psychological factor.

Broken Ego Defenses


I first learned of the concept of "ego defenses" in Alan Deutschman's book Change or Die in which he examines why change is so difficult for many people, groups, organizations and so on. In his opening chapter he looks at the human psychology of denial, rationalization, etc. The more I learned about these psychological defenses of the core self, the more I realized, "hey, that's what I have trouble doing! I can't block these things out or rationalize them away or project blame onto others!" Interviews with and observations of many others told a similar story. 

So let's have a bit more of a look at what these are about. From Deutschman: 

When we find ourselves in seemingly intolerable situations and feel overwhelmed by tension, anxiety and a sense of powerlessness, or when the harsh realities of our lives threaten to crush our self-esteem, our minds activate a powerful built-in automatic psychological strategies to help us cope. We shield ourselves from the threatening and humiliating facts. 

[above emphasis mine - BGE]

... 
Freud called these "ego defenses" and even though many of his ideas have been discredited in the past century, this one particular idea has survived all the critics and become accepted as hard fact.  
...
The book The Ego and its Defenses analyses forty-eight different defenses. Some of the categories are familiar to everyone. We all know about number three, "denial" - literally denying that the problem exists. Number seven is "idealization", which is what happens when you fall so madly in love with the wrong person that you're blind to the person's faults and misdeeds even though they're blatantly obvious to friends and family. And who among us hasn't been guilty of number thirteen, "projection" - blaming others for our own faults? And does a day go by without any one of us engaging number fourteen, "rationalization" in which we come up with creative excuses and stories to cover up the real motives for our behaviour?

We can laugh about these - when we see them in others of course - but these are crucial for day to day survival (and is why we evolved them). These are subconscious mechanisms that kick in automatically without conscious input or even awareness (which is why they work). They work well below your conscious level silently kicking aside anything that threatens your ego - you - from psychological harm. Denial is even what allows you to drive a car - it pushes aside all the danger of possible accidents from your mind so that you can drive without being crippled by fear. Ego defenses allow you to justify your daily actions so that your esteem and confidence stay intact even though you may daily do or see things that could be damaging to you.


Let's briefly look at this so called "psychological harm". 

What is meant when we say psychological harm is in fact psychological pain. In numerous posts now I've alluded to the fact that the brain experiences and reacts to so called psychological pain exactly the same as physical pain that we experience when, for example, we hit our thumb with a hammer. Just then as physical pain triggers the stress response system, psychological pain does as well.

Thus what much of my subsequent study on this subject has revealed more precisely is that these psychological defense systems are really protecting the self from stress for it is the complicated neurobiology of stress that will cause health problems of all kinds and the kinds of mental breakdowns we experience

Stress is the big killer, folks, and "ego defenses" help protect us from it. 

What I've also learned is that when we think of something as "psychological", it has a physiological basis in the brain. In other words, it doesn't arise out of nowhere, the brain produces it. It would require a longish essay to explain this but briefly let's think of consciousness. Everyone in brain studies agrees consciousness exists but nobody knows exactly how the brain produces it. Most neurobiologists and neurologists would agree though that it emerges from physical properties of the brain. And so it is with so called psychological effects. We may not be able to pinpoint exactly where they are located in the brain but we can observe and note their existence and that this existence emerges from physiological properties in the brain. 

"Rationalizations" are the post hoc inner dialogue we experience that "justify" our actions. This can calm down a lot of inner stress and discomfort by "spinning" a different version of events that removes blame and culpability from "you" or "justifies" what was demonstratively
to someone else a bad decision or harmful action. It doesn't matter how your rationalizations look to others, what's important - its sole job - is to keep your ego safe and from melting down from emotional overload. 

Another interesting psychological "self-defense" mechanism is known as "self-enhancement bias" which is nicely described and summarized in How Our Delusions Keep Us Sane. This is a kind of amalgamation of beliefs that include an optimism bias and views of ourselves that protect us from despair. The brain can literally create delusions that make us feel stronger and better equipped that perhaps what we are to face life's battles. 

While all of these play essential roles in getting "you" through life they can, as we should know, cause harm (a topic for another day, I'm afraid) but as long as you're functioning relatively normally - handling day to day responsibilities fine and can get through the day without experiencing overwhelming stress and melting down - that's the main goal as far as these psychological defenses are concerned. Our belief systems are a part of this as beliefs and stories are created to justify your daily decisions and long term plans (no matter how kooky they may appear to others). What's important is that you are relatively confident and self-assured.

A big issue with many of those of us suffering major mental health disorders is that we are anything but confident and self-assured. This becomes a large part of our dysfunction and inability to engage in society and work places. Why would this be? As I wrote in
mental health disorders and reality, suffering (suffering as opposed to living with) from the harsher cases of schizophrenia's delusions and bipolar's severe swings between polar opposite states of mind can severely alter one's concept of reality. It can get to the point - and it has with me - that you don't know what to believe or even know who you are. This is where I was at when I wrote originally wrote this piece. My states of mind would change so often and so radically that I could literally no longer believe anything in my own mind. I'd venture that those with schizophrenia go through the same thing. It's incredibly destabilizing. (2)

For the brain and its mind boggling array of subconscious systems that run your life to operate properly it needs some semblance of day to day stability. This is why most people fall into comfortable routines without their realizing it - their brains are more comfortable that way. And the more comfortable they are the more secure their ego defenses become and the more comfortable their ego systems become the more the routine will be re-enforced. With secure ego defenses one can go through a certain amount of life disruption and those defenses will leap to the rescue. "That's not important!" (denial) "Not my fault" (denial and/or projection). "It was all I could do!" or "They deserved it because <insert reason>! (rationalization) and so on. These may take a day or two to kick in after the initial emotional shock but eventually they will and you'll find yourself more or less at peace with whatever happened. 

Now here's the thing with us mental disorder peeps. We get hit with double whammies. First we'll get hit with great internal disruption - psychotic delusions or a severe manic depressive cycle or a long episode of major depressive disorder. Your inner realities 
WILL get rocked. This WILL cause external life disruptions (if it doesn't cause life disruptions you are not by definition "ill") which further rock your inner world. But no problem, it may take a while but your ego defences will bail you out ("that wasn't so bad" "that didn't really happen" and so on). But then it happens again. And again. And again. Schizophrenia and rapid cycling bipolar can be extremely disruptive like this. And the more these internal and external disruptions happen, the more your inner brain circuitry is going to get rocked too as intense inner conflicts arise and competing subconscious operating systems in your brain fight to right the ship. 

High amounts of inescapable stress will occur (inescapable because the source is your own brain) and this will further damage the operating systems (uber amounts of evidence for this). After a while it just all starts to melt down (and hospitalization is usually necessary). It is my argument that one of the victims of all this internal chaos and stress is the ego defence system. It just simply becomes too confused and doesn't know what to protect from what. For ego defences to work, I posit, they need a solid mental foundation to work upon. Well guess what, with a neuropsychiatric illness that solid mental foundation went out the window a long time ago.

Therefore overwhelming amounts of unpleasantness gets through and pummels the shit out of your ego and your sense of self. This, I also believe, is where much psychic pain originates. Without our ego defences to protect us, all the unbearable shit from life and our own inner hell beats down upon us like a thousand suns. It all becomes incredibly hard to deal with. Or it may over correct and over protect or otherwise malfunction and this is why you'll often see violent behaviour from those with schizophrenia or bipolar (and why four cop cars and and a minimum of six officers showed up for my recent 911 call). We can't construct pleasant realities because all our inner systems have been rocked too much and too often and have no idea what "reality" to construct. Belief in our selves and our world crumble. This is why we often become agoraphobic and isolated.

We can laugh about ego defence systems - until they're broken. Then it's truly a case of you don't know what you've got till it's gone.

People who can "deal" with their mental health issues likely haven't been hit as hard or for whatever reason have stronger ego defences (well, not for whatever reason - it's genetic code and favourable environmental factors). For those of us who are not so blessed, or who simply go through more severe forms of the disorder more often and over a longer period of time, we ain't so lucky. We'll get tied to the whipping post - and good lord it feels like we're dying (
Allman Brothers Whipping Post). And it's the psychic pain that we endure that will become a major part of our suffering. And this, to get to the larger and most important point, is a large reason why suicide is so common among those with schizophrenia, bipolar disorder and major depression - our critical core selves are no longer adequately protected. I realized that when I come out of a bad episode and examine why I felt so dark and suicidal, those systems - denial, et al - aren't shielding me from the worst painful stuff. And it really is like being tied to the whipping post.


(1) - At some point I'll get to recounting my life as it became on psychiatric drugs and under the care of psychiatry.


(2) - Since this writing I have done enormous amounts of work to stabilize my mental states and life circumstances and am now in a much better place mentally. 

[update]

Since coming up with this concept, I've done considerable more research and real world observations. I've interviewed many people about how they experience life, life difficulties and the harsher realities of life and it continually astonishes me what the average person doesn't see or notice in life or can simply brush aside. Or what they simply deny exists (climate change would be a glaring example here). And when I talk to them about it and try to understand why they can't see what I see, it's almost literally as though they're "blind" to problems or suffering in others or they greatly downplay its signficance. 

I've also since done far more research and gained far more experience in identifying psychological stressors and the sources for what many of us know as "psychic pain" (or psychological emotional pain as opposed to physiological sources of pain). 

And what I've concluded is that many of us who suffer psychiatric conditions worse than others cannot - because of how certain brain regions within us are structured - shield ourselves like many people can. Everything gets in, everything gets processed far more intensely. 

When I examined myself in comparison to others who live more or less calm, untroubled and happy lives, what they are oblivious to I get in deep and searing detail. 

There is growing evidence that those within the schizophrenic and bipolar spectrum and, I'd argue, those with long term major depressive disorder have brains that are wired and structured fundamentally differently and not only do we take in much more sensory information than the average person, we process and store it differently. Hence we tend not to be able to shield ourselves from the harsher aspects of life and instead get bombarded with it. This is why we both feel much more inner pain than the average person but also why we tend to hit overwhelm so easily. 

So to summarize, those with so-called strong "ego defenses" simply don't take in or process as much sensory information as we do plus their brains are able to block out (or simply not see or experience) the harsher realities of life whereas for those of us not so blessed, it all gets through and this is a major source not only of our suffering but are triggers for what I'll term "psychiatric episodes" (suicidal meltdowns, psychosis, manic episodes, crushingly black depressive episodes and so on - plus the searing inner pain). 

I am convinced that there is a neuronal basis for all of this - I've seen much growing evidence - but to hunt it all down and put the pieces together is a bit beyond my energy levels right now. It is on my (long, long) to-do list though. 

And the reason I say it's neuronal in basis is that it's important to understand this because it's important for you to understand that it's not "you" being "weak", a "wimp", "too sensitive" and so on, it's how your brain is structured and processes information and creates your conscious experience (which is all brains do). What this also means is that, because of the "plastic" (from the term neuroplasticity) ability of brains to break down old connections and form new ones, it IS possible for a lot of this to be overcome and for you to build up better "ego defenses". 

Since originally writing this piece, I have found that part of lacking the "ego defenses" that others have is being a highly empathetic person. I introduce an understanding of empathy in this post. Though that is about empathy in bipolar people, much of what we learn there can be applied to all highly empathetic people. What I have learned is that part of building stronger "bego defenses" and thus reducing the amount of emotional pain we suffer, is better understanding our empathetic selves and learning to manage it better. 


BGE - February, 2016





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